Herams 1Stquarter 2017 2

[HeRAMS] Health Resources Availability Mapping System

Report: 1ST QUARTER 2017

Turkey Hub Health Cluster for Syria

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HeRAMS (Health Resources Availability Mapping System) is a standardized approach supported by a software-based platform that aims at strengthening the collection, collation and analysis of information on the availability of health resources and services in humanitarian context. It aims to address the needs/gaps expressed by the health cluster on coordination and management by providing timely, relevant, and reliable information.

HeRAMS provides a tool for assessing, monitoring, and processing a comprehensive set of available data collected at health facility level. It covers; geographical location of the HF, demographic data on catchment area, type, functionality, building type, inpatient capacity, managing and supporting partners, health personnel, access and security, and health services provided at different levels of healthcare.

This report provides a summary of the analysis of the available health resources and services in Syria, the report is produced with the data provided mainly by Turkey hub health cluster members national and international non-governmental organizations as well as health authorities.

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1. Distribution of Health facilities Primary Health Care facili�es are classified into different standard categories based on the provision of services, staff pa�ern and popula�on coverage. The following graph provides the distribu�on of the exis�ng health facili�es (sta�c and mobile); in terms of number of the func�onal facili�es.

Figure 1.Distribu�on of func�oning Health facili�es

100 89 90 80 70 66 60 46 50 42 37 40 36 29 30 20 10 10 0 General Hospital Specialized Comprehensive Health Centre Health Unit Mobile clinic Specialized Care Other Hospital Health Centre Facility

Out of 45 main managing health partners, 40 are reported in this quarter, 389 Health facili�es reported, out which 355 func�onal HFs compared to 327 in December 2016.*, 78(22%) are Hospitals, 172(49%) are ﬁxed PHCs, 66 (18%) are mobile clinics, 29 (8%) specialized care facility ** while 10 (3%) *** other health facili�es.

Out of total func�oning health facili�es, 51% of facili�es are in Idleb , 27% in Aleppo, 8% in Hama,6% in ooRural Damascus,4% in Homs, while about 1% in Al-Hasakeh, Ar-Raqqa, Damascus, Dar'a and La�akia

*repor�ng rate increased from 36 partners in December 2016 to 40 in this quarter. ** Specialized health centers (Physical Rehabilita�on centers, Leishmaniosis centers .Etc.) ***Ambulance network, Blood Bank, Central Lab

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2. Functionality status

Figure 2. Functionality status of Health facilities

Functionality has been assessed at three levels: fully functioning which mean open and providing full package of essential services, partially functioning means open but not providing the full package of essential services, or not functioning. Out of 389 66, 17% assessed health facilities, 74% (289) were reported fully functioning, 17% (66) partially functioning, 9% (34) out of 34, 9% service, means that 26% of the facilities were non-functioning or partially functioning with low capacity. See Figure 2. 289, 74% Among non-functioning facilities, 53% were hospitals reported from Aleppo, Rural Damascus, Hama and Idleb respectively.

Fully Functioning Non-functioning Partially Functioning

3. Condition of health facilities Figure 3 Level of Damage infrastructure

The condition of the health facilities infrastructure has been assessed at three levels: fully damaged: major damage requiring 4, 1% 55, 14% complete reconstruction, partially damaged: requiring substantial to large scale repair, and not damaged, 27% (106) health facilities were reported damaged [1% fully damaged and 26% partially damaged], 59% (228) were reported intact, while 14% (55) of 26% 228, 59% health facilities were not relevant to evaluate. See figure 3.

Not damaged Partially damaged Fully damaged Not relevant (e.g mobile clinic)

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4. Health facilities based on date of establishment

The health facilities has been assessed according to Figure 4 New establlished HFs whether the health facility exist prior to the crisis or new established health facilities, 67% (238) health facilities were newly established, while 33% (117) of health facilities were prior to the crisis. See figure 4.

Out of the new established health facilities 35% were 33% established in new building, 21% works in residential building, 17% in governmental Building, 6% in schools and 21% in others public building. 67%

New established HFs Prior to the crisis health facility

5. Health facilities delivery points Figure 5 Delivery point types

84% health facilities are located in settlements while 16% are located in IDP camps. HF located in IDP Camp Its worth to mention that 58% of HF located in 5% and serving exclusively 11% IDPs settlement are also serving IDPs and 11% of IDP HF located in IDP Camp facilities are also serving residents but also serving Residents

HF located in Settlement 58% 26% and serving exclusively Residents HF located in Settlement but also serving IDPs

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6. Health facilities resources

Figure 6: Accessibility to patients Figure 7: Electricity Figure 8: Water Sources

0% 4% Fully Functioning 1% Fully accessible 31% Non-functioning Not accessible Available 63% Not available Not available 96% Partially 99% accessible 6% Partially 0% Functioning

4% of functioning facilities reported difficulties in 37% of the functioning facilities works 1% of the facilities are without water accessibility mainly due to security reasons without/with an interrupted electricity services

Figure 9: Availability of chlorine tablets

25% 23% Only 23% of functioning facilities with sufficient chlorine tablets.

24% 28%

Sufficiently Insufficiently Not available Not applicable

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7. Provision of General Clinical Services

Figure 10:Outpatient services: 100% The main reasons for the lack of 5% 10% 90% 17% 20% 20% availability of outpatient services are 80% 38% 38% lack of health Staff, Lack of finances and 70% Lack of medical supplies (drugs and 60% consumables). 50% 95% 90% 40% 83% 80% 80% 30% 62% 62% 20% 10% 0% Comprehensive General Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Hospital Facility Hospital

Available Not available

Figure 11: Inpatient capacity 100% 3% 5% 90% The availability of inpatient services in 80% the general and specialized hospitals is 70% 68% more than 95%, while 11% of these 60% hospitals provide inpatient services 50% 97% 95% with low capacity. 40% 30% It’s worth to mention that only 32% of 20% 32% the comprehensive health centers are 10% providing inpatient service while it’s 0% necessary as per essential primary Comprehensive Health Centre General Hospital Specialized Hospital health care package. Available Not available

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Figure 12:*Basic Laboratory Services 100% 3% 90% In hospitals basic laboratory services 24% 80% availability is about 99%, while 76% of 70% 63% 61% comprehensive health Centers 76% 60% 83% providing basic laboratory Services. 50% 97% 100%

40% 76% *CBC, urine analysis, stool microscopy, sputum 30% microscopy 20% 37% 39% 24% 10% 17% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 13: *Basic Imaging Service 100% 3% 90% 14% 91% of the hospitals provide Basic 80% imaging services. 70% 59% 74% 60% 83% 96% 95% 50% 97% 40% 86% 30% *X-Ray and Ultrasound 20% 41% 26% 10% 17% 0% 4% 5% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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Figure 14: Pharmacy having Essential 100% 0% 5% 3% 2% Drugs 11% 6% 90% 80% Most of the reported health facilities 45% have pharmacy having essential drugs. 70%

60% 40% provide it partially as there is no 50% 100% 95% 97% 98% sustainable drugs and consumables 89% 94% supplies system. 40% 30% 55% 20% 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

100% 3% 3% 5% 90% 15% Figure 15:Referral capacity 80% 39% 52% 71% of the facilities have referral 70% 61% mechanism in place, such as 60% communication and safe 50% 97% 97% 95% transportation. The main reason for 40% 85% inadequate referral mechanism in 30% 61% 48% some facilities provides is the shortage 20% 39% of vehicles and finance required for 10% fuel. 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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8. Provision of Surgery services

Figure 16: *Primary Injury care 100% 0% 90% 19% 33% 61% of the facilities are providing 80% 43% 36% 70% 62% 69% primary injury care. 60% 50% 100% *Treatment of open wounds, fracture 40% 81% 67% immobilization, patient stabilization and proper 30% 57% 64% referral (including antibiotics and tetanus toxoid 20% 38% 31% when needed) 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 17:*Trauma, surgical care, 100% 0% 90% and elective surgery 26% 80% 86% of the hospitals are providing 70% trauma, surgical care, and elective 60% 84% surgery. 50% 100% 40% 74% *At least 1 operation room with/without gas 30% anaesthetic 20% 10% 16% 0% Comprehensive Health Centre General Hospital Specialized Hospital

Available Not available

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Figure 18:Intensive Care Unit 100%

58% of the hospitals are with 80% 33% 50% intensive care unit. 60% 33% of the general hospital lack 40% intensive care mainly due lack of 67% 50% medical supplies. 20%

0% General Hospital Specialized Hospital

Available Not available

Figure 19:Blood bank services 100% 90% 49% of the hospitals provide blood 80% bank services. 44% 57% 70% 60% 92% There are two blood banks, one each 50% in Idleb and Aleppo governorates 40% outside the health facilities. 30% 56% 20% 43% 10% 8% 0% Comprehensive Health Centre General Hospital Specialized Hospital

Available Not available

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100% Figure 20: *Physical rehabilitation 90% services 80% 70% 69% Only 15% of the facilities provide 60% 78% 89% 86% 86% physical rehabilitation services. 50% 93% 40% *Disabilities rehabilitation & support 30% 20% 31% 10% 22% 11% 14% 14% 0% 7% Comprehensive General Hospital Health Centre Health Unit Specialized Care Specialized Hospital Health Centre Facility

Available Not available

9. Provision of maternal & newborn and child health services

Figure 21:*IMCI 100% 50% of the facilities provide IMCI, of 90% 22% 80% 38% 43% which 35% partially due to lack of 48% finances and trained health staff. 70% 61% 60% 74% 86% *Integrated Management of Childhood Illness 50% IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI 40% 78% aims to reduce death, illness and disability, and to 30% 62% 57% promote improved growth and development 52% among children under five years of age 20% 39% 10% 26% 14% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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Figure 22:*Screening of acute 100% 11% malnutrition 80% 37% 30% 50% 45% 60% of the facilities provide 60% 76% screening of acute malnutrition, of 40% 89% 70% which 30% partially due to lack of 63% 55% 20% 50% finance and equipment. 24% 0% Comprehensive General Hospital Health Centre Health Unit Specialized Care Specialized Hospital *MUAC or Weight for Height, and/or bilateral Health Centre Facility pitting oedema Available Not available

Figure 23: Outpatient treatment of 100% acute malnutrition 80% 38% 47% 46% 48% 61% 58% 48% of the facilities provide 60% 79% 40% outpatient treatment of acute 62% 53% 54% 52% 20% 39% 42% malnutrition, of which 40% provide 21% it with some limitations due to lack of 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized medical supplies. Health Centre Facility Hospital

Available Not available

Figure 24: *Antenatal Care 100% 5% 13% 73% of the facilities provide 90% 24% 80% 35% 41% antenatal care. 49% 70% 60% *Antenatal Care: Assess pregnancy, birth and 50% 95% emergency plan, respond to problems (observed 87% and/or reported), advise/counsel on nutrition & 40% 76% 30% 65% 59% breastfeeding, self-care and family planning, 51% preventive treatment(s) as appropriate 20% 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Hospital Health Centre

Available Not available

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Figure 25: *BEmONC 100% 16% 90% 24% 71% of the hospitals and 80% 49% 70% Comprehensive PHCs are providing 66% 63% 60% 79% BEmONC. 88% 50% 84% *Basic Emergency Obstetric and Newborn 40% 76% 30% Care (BEmONC) package includes Parenteral 51% 20% antibiotics + oxytocic/anticonvulsant drugs + 34% 37% 10% 21% manual removal of placenta + removal of 12% retained products with manual vacuum 0% aspiration (MVA) + assisted vaginal delivery Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized 24/24 & 7/7 new-born care includes: Basic Health Centre Facility Hospital new-born resuscitation + warmth Available Not available (recommended method: Kangaroo Mother Care - KMC) + eye prophylaxis + clean cord care + early and exclusive breast feeding

Figure 26:Comprehensive 100% emergency obstetric care (CEmOC)* 90% 21% 80% 51% 59% of the hospitals and the 70% 54% comprehensive health centers are 60% providing CEmOC. 50% 40% 79% 30% *CEmOC includes BEmONC +surgery+ 49% 20% 46% anesthesia+ blood transfusion. 10% 0% Comprehensive Health Centre General Hospital Specialized Hospital

Available Not available

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9. Provision of treatment for non-communicable diseases and mental health

Figure 27: Treatment of High Blood 100% 3% 2% Pressure and Cardiovascular 14% 80% 35% 33% Diseases 45% 66% 76% of the facilities provide 60% 97% 98% treatment of HBP and cardiovascular 40% 86% 65% 67% diseases. 55% 20% 34% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 28:Treatment of diabetes 100% 3% 2% 14% 80% 35% 30% 40% 77% of the facilities are provide 66% 60% treatment of diabetes. 97% 98% 40% 86% 65% 70% 60% 20% 34% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 29:Mental Health Care* 100% 80% Only 20% of the primary health 60% 79% 72% facilities provide mental health 89% 80% 86% services. 40% 20% 28% 21% 20% 14% Mental health includes: Support 0% 11% of acute stress and anxiety, front line Comprehensive Health Health Centre Health Unit Mobile clinic Specialized Care Facility management of common and severe mental Centre disorders Available Not available

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10. STI & HIV/AIDS and sexual violence

Figure 30: Syndromic management 100% of sexually transmitted infections 80% 57% 57% 65% 69% 70% 60% 77% 83% 32% of the facilities provide this service. 40% 43% 43% 20% 35% 31% 30% 23% 17% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 31: HIV counselling and 100% testing 80%

60% 78% 76% Only 13% of the facilities provide 86% 90% 87% 94% HIV counselling and testing. 40% 20% 24% 14% 22% 13% 0% 10% 6% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Hospital Health Centre

Available Not available

Figure 32: Clinical management of 100% rape survivors* 90% 80% 51% 55% 31% of the facilities provide clinical 70% 65% 60% 77% 75% 79% 72% management of rape survivors 50% 40% 30% 49% 45% *Including psychological support 20% 35% 25% 28% 10% 23% 21% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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11. Community health services

Figure 33: Health Education

Out of functioning HFs 66% of the 100% facilities provide health education 90% 22% 26% 37% 33% services. 80% 40% 45% 40% 69% of the PHC facilities and 60% of 70% 60% hospitals provide health education 50% services. 40% 78% 74% 63% 67% 30% 60% 55% 60% 20% 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 34:Screening for malnutrition 100% (MUAC) 90% 16% 80% 51% 45% 45% 49% of the facilities provide 70% 56% screening for malnutrition through 60% 74% 76% outreach services. 50% 84% of the comprehensive health 40% 84% 30% centers provide the screening service. 49% 55% 55% 20% 44% 10% 26% 24% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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Figure 35: Follow up of 100% malnourished children 90% 19% 80% 49% 43% 46% 45% 53% of the facilities follow-up 70% 55% malnourished children, out of which 60% 79% 37% are follow-up partially due to 50% lack of finances. 40% 81% 30% 51% 57% 54% 55% 20% 45% 10% 21% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

Figure 36:Screening for pregnancy 100% 3% 17% for referral to ANC: 90% 26% 80% 40% 50% 50% 65% of the facilities provide 70% screening for pregnancy and referral 60% 76% for ANC. 50% 97% 83% The highest provision of this service is 40% 74% 30% 60% through Comprehensive centers 50% 50% 20% (97%). 10% 24% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital

Available Not available

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12. Gap in Health Staff

Figure 37: percentage of HFs without general medical doctors Figure 38:percentage of HFs without nurses

Specialized Hospital 33% Specialized Hospital 0%

Mobile clinic 35% Mobile clinic 3%

Health Unit 46% Health Unit 2%

Health Centre 36% Health Centre 0%

General Hospital 19% General Hospital 0%

Comprehensive Health Centre 24% Comprehensive Health Centre 0%

0% 10% 20% 30% 40% 50% 0% 5% 10% 15% 20% 25% 30%

Figure 39: Percentage of HFs without internists Figure 40: Percentage of HFs without Paediatrician

Specialized Hospital 69% Specialized Hospital 24%

Health Unit 65% Health Unit 61%

Health Centre 46% Health Centre 36%

General Hospital 42% General Hospital 36%

Comprehensive Health Centre 30% Comprehensive Health Centre 5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 0% 10% 20% 30% 40% 50% 60% 70%

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Figure 41:Percentage of HFs without Gynaecologist Figure 42:percentage of HFs without Midwife

Specialized Hospital 19% Specialized Hospital 26%

Mobile clinic 39%

Health Centre 67% Health Unit 43%

Health Centre 19% General Hospital 56%

General Hospital 53%

Comprehensive Health Centre 38% Comprehensive Health Centre 8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 0% 10% 20% 30% 40% 50% 60%

Figure 43: :Percentage of hospitals without surgeon

62% Specialized Hospital 40%

17% General Hospital 6%

0% 10% 20% 30% 40% 50% 60% 70%

Orthopaedic surgeon General surgeon

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Table 1: Distribution of health staff by districts/populations (Aleppo/Idleb)

General General Orthopedic Pharmacist/ Governorates/District Population* #Hospitals #PHCs** medical Pediatrician Gynecologist Internist Midwife Nurse CHWs surgeon surgeon dispenser doctor Aleppo/Jebel Saman 540,456 7 32 35 12 9 18 13 14 39 210 38 26 Aleppo/Al Bab 82,527 0 1 0 0 0 1 0 1 0 1 0 0 Aleppo/Afrin 308,328 1 6 14 2 2 6 9 10 12 42 15 10 Aleppo/A'zaz 345,116 7 25 79 25 9 35 13 14 47 201 93 36 Aleppo/Ain Al Arab 127,951 0 1 1 0 0 0 0 0 0 3 0 1 Aleppo/As-Safira 47,370 0 1 0 0 0 0 1 1 0 3 4 1 Aleppo/Jarablus 73,256 0 7 11 0 0 5 0 2 7 13 15 6 Aleppo/ Menbij 413,691 0 2 0 0 0 3 2 1 5 7 6 1 Idleb/Idleb 471,920 8 24 101 16 18 29 23 21 52 339 50 34 Idleb/Al Ma'ra 437,511 12 24 135 27 18 34 34 22 72 330 98 41 Idleb/Harim 597,858 13 39 127 17 21 43 39 33 76 363 117 69 Idleb /Jisr-Ash- 202,141 5 14 18 13 9 16 8 11 29 153 71 21 Shugur Idleb/Ariha 181,699 3 14 11 7 4 18 10 15 33 106 44 14 Total 3,829,824 56 190 532 119 90 208 152 145 372 1,771 551 260

*population data source is NPM, with focus in the area of operation for Jebel Saman district

*Total of the 4 levels of PHC

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13. Global health indicators and benchmarks a. Number of health workers (medical doctors + nurse + midwife) per 10,000 population, by administrative unit (benchmark >22 HWs for 10,000 population)

Number of health Available for every Gap in Health Governorates/District Population STD No of HWs %Gap workers 10,000 pop Workers Aleppo/Jebel Saman 540,456 350 6 1243 893 72% Aleppo/Al Bab 82,527 3 0 190 187 98% Aleppo/Afrin 308,328 97 3 709 612 86% Aleppo/A'zaz 345,116 423 12 794 371 47% Aleppo/Ain Al Arab 127,951 4 0 294 290 99% Aleppo/As-Safira 47,370 5 1 109 104 95% Aleppo/Jarablus 73,256 38 5 168 130 77% Aleppo/ Menbij 413,691 18 0 951 933 98% Aleppo 1,938,695 938 5 4459 3521 79% Idleb/Idleb 471,920 599 13 1085 486 45% Idleb/Al Ma'ra 437,511 672 15 1006 334 33% Idleb/Harim 597,858 719 12 1375 656 48% Idleb /Jisr-Ash- Shugur 202,141 257 13 465 208 45% Idleb/Ariha 181,699 204 11 418 214 51% Idleb 1,891,129 2,451 13 4350 1899 44%

b. Number of Community health workers per 10 000 population, by administrative unit(benchmark >=10 CHWs for 10,000 population)

Available for every STD No of Gap in Health Governorates/District Population Number of CHWs %Gap 10,000 pop CHWs Workers Aleppo/Jebel Saman 540,456 38 1 540 502 93% Aleppo/Al Bab 82,527 0 - 83 83 100% Aleppo/Afrin 308,328 15 0 308 293 95% Aleppo/A'zaz 345,116 93 3 345 252 73% Aleppo/Ain Al Arab 127,951 0 - 128 128 100% Aleppo/As-Safira 47,370 4 1 47 43 92% Aleppo/Jarablus 73,256 15 2 73 58 80% Aleppo/ Menbij 413,691 6 0 414 408 99% Aleppo 1,938,695 171 1 1,939 1,768 91% Idleb/Idleb 471,920 50 1 472 422 89% Idleb/Al Ma'ra 437,511 98 2 438 340 78% Idleb/Harim 597,858 117 2 598 481 80% Idleb /Jisr-Ash- Shugur 202,141 71 4 202 131 65% Idleb/Ariha 181,699 44 2 182 138 76% Idleb 1,891,129 380 2 1,891 1,511 80%

P a g e | 23 c. Number of hospital beds per 10 000 population (inpatients & maternity), by administrative unit (benchmark >=10 beds for 10,000 population)

Total STD no. of Governorates/District Population #Hospitals #PHCs available Gap %Gap beds beds Aleppo/Jebel Saman 540,456 7 32 540 166 374 69% Aleppo/Al Bab 82,527 0 1 83 0 83 100% Aleppo/Afrin 308,328 1 6 308 35 273 89% Aleppo/A'zaz 345,116 7 25 345 522 -177 No Gap Aleppo/Ain Al Arab 127,951 0 1 128 1 127 99% Aleppo/As-Safira 47,370 0 1 47 3 44 94% Aleppo/Jarablus 73,256 0 7 73 3 70 96% Aleppo/ Menbij 413,691 0 2 414 0 414 100% Aleppo 1,938,695 15 75 1,939 730 1,209 62% Idleb/Idleb 471,920 8 24 472 305 167 35% Idleb/Al Ma'ra 437,511 12 24 438 355 83 19% Idleb/Harim 597,858 13 39 598 477 121 20% Idleb /Jisr-Ash- Shugur 202,141 5 14 202 129 73 36% Idleb/Ariha 181,699 3 14 182 65 117 64% Idleb 1,891,129 41 115 1,891 1,331 560 30% d. Number of HF with Basic Emergency Obstetric Care/ 500 000 population, by administrative unit benchmark >= 4 BEmOC/500 000)

Governorates/District Population* Available BEmOC STD no. of BEmOC HFs Aleppo/Jebel Saman 540,456 13 4 Aleppo/Al Bab 82,527 0 1 Aleppo/Afrin 308,328 5 2 Aleppo/A'zaz 345,116 10 3 Aleppo/Ain Al Arab 127,951 0 1 Aleppo/As-Safira 47,370 0 1 Aleppo/Jarablus 73,256 2 1 Aleppo/ Menbij 413,691 1 3 Aleppo 1,938,695 31 16 Idleb/Idleb 471,920 14 4 Idleb/Al Ma'ra 437,511 21 4 Idleb/Harim 597,858 22 5 Idleb /Jisr-Ash- Shugur 202,141 10 2 Idleb/Ariha 181,699 7 1 Idleb 1,891,129 74 15

P a g e | 24 e. Number of HF with Comprehensive Emergency Obstetric Care/500 000 population, by administrative unit (benchmark >= 1 CEmOC/500 000)

Governorates/District Population* Available CEmOC STD no. of CEmOC HFs Aleppo/Jebel Saman 540,456 8 1 Aleppo/Al Bab 82,527 0 1 Aleppo/Afrin 308,328 1 1 Aleppo/A'zaz 345,116 7 1 Aleppo/Ain Al Arab 127,951 0 1 Aleppo/As-Safira 47,370 0 1 Aleppo/Jarablus 73,256 3 1 Aleppo/ Menbij 413,691 0 1 Aleppo 1,938,695 19 4 Idleb/Idleb 471,920 8 1 Idleb/Al Ma'ra 437,511 13 1 Idleb/Harim 597,858 16 1 Idleb /Jisr-Ash- Shugur 202,141 5 1 Idleb/Ariha 181,699 4 1 Idleb 1,891,129 46 4

Community Population Provision of primary health care in Aleppo and Idleb 0 - 5,000 Zobar - Ain Al Oruba - Zorabi 5,000 - 10,000 Kor Ali Sus - Arab Susan Ghassaniyeh - Naf Karab Zur Shakriyeh Qorret Halanj - Karabnaf Qalam - Big Ein 10,000 - 30,000 Maghar - Mashko Qarruf Kharan Bandrak Kort Elbat Batra Halawaniyeh Upper Shoruq - Sara Qorna Rajabiyeh - Little Salameh Ada Marsawa Treikhem Himar Shyookh Zarak Qantarte Holaqi Marwiyeh Middle Qojli - Little Danquz 30,000 - 60,000 Okan Dama - Arab Qandariya Tal Karb Sharqan Ser - Tal Aghbar - Hifyana Beith Serri Haidar Ayki Dam Haji Azzah Elamara Qanaya Karbalak Almadar Qotan Sarnjak Tal Elagher Hadra - Sreisat Billeh - Bugas Kufyan Turkey Obasi Birein - Ras Wali Qubbet Dabis Haj Bayaa Silsileh Big Baldaq Maghayer - Jaadet Upper Mawa - Sheikh >60,000 Jtal Qoyo Ahmar Yiji Zyaret Elturkman Seifiyeh Khalil Ali Amud Talil Zayzafun Qorra Qorq Mghar Elsamawat Upper Khanik Ghali Karsanli Big Arab Omariyeh Eskeif - Turkey Mazraa Elbab Big Little Hasan Yatimeh - Bazan Elsham - Ekdeh Hasan Kherbet Elkafer Smal Maarin Qazal Matmana Nabgha Shahid Saan Elghazal Arnabiet - Omrek Mand - Koshkar Inaccessible Klkawi Oksozli Tat Hims Kabiret Manbaj Majra - Kawer Khrab Qrat Mil Arab-Shekho Bafelyun Nayara Ar-Raee Atharia Shawa Doshan Mandak Sahm - Doha Odaya Sandara Eastern Bilis - Bashli - Buz Kij Qabab Bonyeh Sarin Ras El µ Big Dib Azaz Yahmul Sandi Tlilet Sheib Mgheirat Shish Afrin Farat Shweihet - Qarajleh Tal Elthaaleb Mabtali Ehteimlat Tal Aar Tal Big Nejem Ein Qabli Khan Mamid - Shawarghet Kafra Ghorur Elbab Sayada Kheznawi PHC Coverage 5 Kms - Sheikh Jqali Amiriya - Qastal Hardana Shweiha Rasm Hayyeh Milheh Khan Mohammed Khadraa Eljoz Kaljibrin Dabeq Kaeebeh Eisheh Kherbet Hajar Castle Big Kamit - Big Meirkan Nireh Hawa Manaq Tlaline Qabtan Sheikh Tal Jurneyyeh Ilan Little enbij Sheikh Afrin Enab Hiwar Tarhin Elsheyab M Elmashrafeh Hafyan Shakif Kojeh Kamit Marata Bayada - JarrahJerji Omyaniye Madneh Abyad Big El-Hadid Western Tharifa Tellejar Tall Elnahr Rasm Walia - Eastern Shallal Neighboring_Countries Lower Bablit Sheikh Mare Aq Burhan Su Sinbat - Korhyok Kherbet Zuraikat Arima Big Um Myal Big Jeb Elakhdar Akirdali Little Dabaa Sayyeda - Eastern Jokhar Sinnara Khaltan Kafardali Bteita Deir Refaat Issa Ghoz Olasha Bashar Koran Shdud Osajli Jafatlak Big Elkalb Nmuqbilet Fors Khatuniyeh Qolana Jableh - Sheikh Abel Bseileh Jmal Kafr Naseh Samuqet Teltana Sheikh Hadath Hota Little Sakawiyeh Jandris Kimar Eskar Qabasin Um Adae Mohtaraq Hassan Agha Abu Daameh al Dandushan Berdag Mediterranean_Sea Rahman Kafin Tal Refaat Aazaz Elwan Olan Miloyran Abu Quraa Mahshiet Western Hosniyeh Massoudieh Bir Tell Freiriyeh N Waqqah Ajami Mandil Nahliya - Eltawahin Maarset Ahras Um Jern Eshkab Brad a b - Hsajek Taanah Bazagha Little Maqtala Eldam Hamam Burj ul Telqraq Qemmet Abu Nahliya Manbaj Jeb Sheikh Naqut Abiad Tal Slur Baee Zahraa Elkhan Btoshiyet Sukariyeh Jdidet Um Tleil Nisriyeh Upper Eskan Elqas Retyan Maratet Sheikh Daghelbash Abu Kahf Himar Obeid Ramala Bir Basufan Byanun Elbab Elhomor Bir AmaaBathiyeh - Damman - Diwan Elmosalamiyeh Kif Taltal Qasr Amudiyeh Jis Rummana Kardoshan Dalleh Selwa Fafertein Hayyan Western Krana Atma Kafrantin Bashmra Musallamiyeh Oweishiyeh Elbreij Tal Ramilet Turkey Qah Zarzita Andan Madyuneh Arran Kherbet Daret Aleppo Magharet Elhenno Wadi Elnur Qabtan Kafr Al-Mallah Mran Manther Big Abu Aswad Aqrabat Azza Sheikh Dakhireh Barguth Shajra - Kur Wadin Eljabal Bssin Kafr Eisheh Abu Jabbar Khofiyet Marufa - Deir Hassan Babis ShamerBarlahin Qatar Eljarf Jadha Hur Aleppo Zayat Aabad Elhomor Little Sakuleh Hamra Naqqarin Sein Sharbaa Rasm Elkibir Zaaraya Harim - Darhashan Anjara Kafr Qasr Ashini Qobab Tlul Torlaha Dana Arhab Aleppo Tiyara Sifa Efesh - Ilkana Kafr Hoteh Dael Um Elamad Hadleh Jeser Sayed Kafr Mu Sarmada Sahara Aleppo Big Tal Elsus Qasr Sallum Little Ariba Htan Deryan Kafr Oweijel Alsafira Western Maksour Khalil Abzemo Khan Balat Hmeimeh - Abu Sus - Tannuza Habbuba Eskat Kafr Radwa Karmin Tal Tal Ein Kweires Akula Tal Jakara Halazon Big Orm Al-Asal Halabiyeh Mabuja Um Adase Abaja Salqin Kila Batbu Atareb Hreibel Shgheib Big Eastern Babiri - Delbiya Kafr Little Khantuman Hasel Sabel Totun Koknaya Kelly Jeineh Hazaza Khalilieh Lower Babiri Hamziyeh Takharim Orm Qarras Haddadin Terkan Zubayda Rasm Elkhamis Kaftin Abin Esan Tal Naam Kisumeh Big Qawas Hamra Armanaz Arada Hmeira As-Safira Jbul Hamra Kafr Kafr - Samaan Kafr Azzan Ein Abu Jrin Tal Jarrah Tellemar Shekh Zeitan a Ar-Raqqa Kafrehmul Ketyan Aleppo Bashkwi Hassan Bahr Nabi Qamari Abtin Assan Al-Safira Berna q Kassibeh Sfira Safira Upper Ras El Ein Zanbaqi Kharab Al-Swagheih Bawabiyeh Ziraa Qabtin Murin Mamimeh Nasriyeh q Mediterranean Dorriyeh Zahraa - Habat Iss Kafr Habshiyeh Hekleh Bumane Sultan Foah Teftnaz Rasim Hadher Wadi Kafr Kar Jaara Sheikh Mahsana a Kherbet Amud Toum Sheikh Obeid Banan Tata Um Amud Mujamaa Nasra Zarzur Yousef Bennsh Sahrij Maryuda Elsonue Bluzeh Smad Khefseh Kherbet

Hettin R Sea Ghafar Idleb Ahmed Mashrafet Emeiriyeh Hamama - Idleb Tal Mamu Saeebiyeh Fajdan Elkhathdraf - Tiba - Tab Issa - Eastern Abad Elbuwaiditein Rasm Kherbet Kafr Debbin r Katrin And Western Sarmin Afs Khuwara Zyare Hober Lower Jeb Southern Aziziyeh Eljoz Um Rish Qminas Talafeh Semaan Batranah Assan Jdeiah Janudiyeh Berjhab Falyun Antash A Ein Kniseh Mastumeh Nayrab Rasafa Tal Eastern Jafr Mansur BigA Bab Saraqab Salamin Jazraya Hajeb leppo Muftahiyeh Upper Shghur Kastanah Nahliya Allush Atshana Simaan Establat Jeb Rasm Shallala Ajuziyeh El-Bayda Ellah San Rabeeah Jeb Fawqan Majdaliya Gharirifeh Hamad Kafr Taljineh Batha Shweihet Elhanuteh Tineh Elali Zabad Badama Bteibat Maalaqa - Sanghara Ariha Mardikh Tawil Tal Tarfawi Harbikeh Ath-Thawrah Najiyeh Omeim Ellahib Maktaba BishlamonMarj Kadoura Maar Elsheikh Wasita Andan Khanaser Qleiah Halluz Nahleh Sheikh Sultan Aabad Kinda Ghanya Jannet Baydar Maalali Dibsi Lof Ballisa Baragethi Elsheikh Sheikh Rasm Frikeh Idris Tabara Elqora Shamsu Marayan Thahabiyeh Castle Elsayaleh Shinan Ruwaiha Tal Hazzan Elksheir Menbij Sahen Joseph Ehsem Jarada Dibis Halban Um Tinet Tal Nuwara Lattakia Banin Maasaran Big As-Safira Ein Balyun Babilla Rasm Simaan Maar Barsa Rasm Sabha Laruz Bara Hantutin Ghadqa Ferwan Nayyas Bayaa Shurin Ward Mozra Qatra Rasm Qoqfin Kafruma Telamnas Ojeh Harmala Eljahsh Oleis L Has Maar Jarjnaz Abu Al-Halubi Ftireh Kafr Hamdieh Sayadi Farja Um Tmakh a Al-Haffa Shamarin Makki Khyara Fleifel Nobol Eastern Sanjar Samaan t Tqana Qaratli Borj Um Aj t Northern Jbala Maysruneh Sarja Southern Ghazileh Um Qrun - a Sheikh Northern Thleijeh Rasha Faqie Tah Abu Um Mweilat Um Jaran k Dames Msheirfeh i Tramla Habbeh Farja Nibaz Khayriyeh a Lweibdeh Rakaya Tahtaya Tellemara Baarbu Sijneh Moqa Big Um Sehrij Tal Qasabiyeh Madaya Khwein Eastern Halawa Khan Tamanaah Abu Tal Tal Lweibdeh Al-Qardaha Hbit Shaykun Dali As-Suqaylabiyah Skik Maraq Dajaj Khanzir Tama Hama

Jablah Muhradah

Hama As-Salamiyeh Banyas Tadmor Tartous Masyaf Homs Sheikh Homs Al Makhrim Tartous Badr Dreikish Homs Homs Ar-Rastan Al Makhrim Tadmor Community Population Provision of secondary health care in Aleppo and Idleb 0 - 5,000 Zobar - Ain Al Oruba - Zorabi 5,000 - 10,000 Kor Ali Sus - Arab Susan Ghassaniyeh - Naf Karab Zur Shakriyeh Qorret Halanj - Karabnaf Qalam - Big Ein 10,000 - 30,000 Maghar - Mashko Qarruf Kharan Bandrak Kort Elbat Batra Halawaniyeh Upper Shoruq - Sara Qorna Rajabiyeh - Little Salameh Ada Marsawa Treikhem Himar Shyookh Zarak Qantarte Holaqi Marwiyeh Middle Qojli - Little Danquz 30,000 - 60,000 Okan Dama - Arab Qandariya Tal Karb Sharqan Ser - Tal Aghbar - Hifyana Beith Serri Haidar Ayki Dam Haji Azzah Elamara Qanaya Karbalak Almadar Qotan Sarnjak Tal Elagher Hadra - Sreisat Billeh - Bugas Kufyan Turkey Obasi Birein - Ras Wali Qubbet Dabis Haj Bayaa Silsileh Big Baldaq Maghayer - Jaadet Upper Mawa - Sheikh >60,000 Jtal Qoyo Ahmar Yiji Zyaret Elturkman Seifiyeh Khalil Ali Amud Talil Zayzafun Qorra Qorq Mghar Elsamawat Upper Khanik Ghali Karsanli Big Arab Omariyeh Eskeif - Turkey Mazraa Elbab Big Little Hasan Yatimeh - Bazan Elsham - Ekdeh Hasan Kherbet Elkafer Smal Maarin Qazal Matmana Nabgha Shahid Saan Elghazal Arnabiet - Omrek Mand - Koshkar Inaccessible Klkawi Oksozli Tat Hims Kabiret Manbaj Majra - Kawer Khrab Qrat Mil Arab-Shekho Bafelyun Nayara Ar-Raee Atharia Shawa Doshan Mandak Sahm - Doha Odaya Sandara Eastern Bilis - Bashli - Buz Kij Qabab Bonyeh Sarin Ras El µ Big Dib Azaz Yahmul Sandi Tlilet Sheib Mgheirat Shish Afrin Farat Shweihet - Qarajleh Tal Elthaaleb Mabtali Ehteimlat Tal Aar Tal Big Nejem Ein Qabli Khan Mamid - Shawarghet Kafra Ghorur Elbab Sayada Kheznawi SHC Coverage 15 Kms - Sheikh Jqali Amiriya - Qastal Hardana Shweiha Rasm Hayyeh Milheh Khan Mohammed Khadraa Eljoz Kaljibrin Dabeq Kaeebeh Eisheh Kherbet Hajar Castle Big Kamit - Big Meirkan Nireh Hawa Manaq Tlaline Qabtan Sheikh Tal Jurneyyeh Ilan Little enbij Sheikh Afrin Enab Hiwar Tarhin Elsheyab M Elmashrafeh Hafyan Shakif Kojeh Kamit Marata Bayada - JarrahJerji Omyaniye Madneh Abyad Big El-Hadid Western Tharifa Tellejar Tall Elnahr Rasm Walia - Eastern Shallal Neighboring_Countries Lower Bablit Sheikh Mare Aq Burhan Su Sinbat - Korhyok Kherbet Zuraikat Arima Big Um Myal Big Jeb Elakhdar Akirdali Little Dabaa Sayyeda - Eastern Jokhar Sinnara Khaltan Kafardali Bteita Deir Refaat Issa Ghoz Olasha Bashar Koran Shdud Osajli Jafatlak Big Elkalb Nmuqbilet Fors Khatuniyeh Qolana Jableh - Sheikh Abel Bseileh Jmal Kafr Naseh Samuqet Teltana Sheikh Hadath Hota Little Sakawiyeh Jandris Kimar Eskar Qabasin Um Adae Mohtaraq Hassan Agha Abu Daameh al Dandushan Berdag Mediterranean_Sea Rahman Kafin Tal Refaat Aazaz Elwan Olan Miloyran Abu Quraa Mahshiet Western Hosniyeh Massoudieh Bir Tell Freiriyeh N Waqqah Ajami Mandil Nahliya - Eltawahin Maarset Ahras Um Jern Eshkab Brad a b - Hsajek Taanah Bazagha Little Maqtala Eldam Hamam Burj ul Telqraq Qemmet Abu Nahliya Manbaj Jeb Sheikh Naqut Abiad Tal Slur Baee Zahraa Elkhan Btoshiyet Sukariyeh Jdidet Um Tleil Nisriyeh Upper Eskan Elqas Retyan Maratet Sheikh Daghelbash Abu Kahf Himar Obeid Ramala Bir Basufan Byanun Elbab Elhomor Bir AmaaBathiyeh - Damman - Diwan Elmosalamiyeh Kif Taltal Qasr Amudiyeh Jis Rummana Kardoshan Dalleh Selwa Fafertein Hayyan Western Krana Atma Kafrantin Bashmra Musallamiyeh Oweishiyeh Elbreij Tal Ramilet Turkey Qah Zarzita Andan Madyuneh Arran Kherbet Daret Aleppo Magharet Elhenno Wadi Elnur Qabtan Kafr Al-Mallah Mran Manther Big Abu Aswad Aqrabat Azza Sheikh Dakhireh Barguth Shajra - Kur Wadin Eljabal Bssin Kafr Eisheh Abu Jabbar Khofiyet Marufa - Deir Hassan Babis ShamerBarlahin Qatar Eljarf Jadha Hur Aleppo Zayat Aabad Elhomor Little Sakuleh Hamra Naqqarin Sein Sharbaa Rasm Elkibir Zaaraya Harim - Darhashan Anjara Kafr Qasr Ashini Qobab Tlul Torlaha Dana Arhab Aleppo Tiyara Sifa Efesh - Ilkana Kafr Hoteh Dael Um Elamad Hadleh Jeser Sayed Kafr Mu Sarmada Sahara Aleppo Big Tal Elsus Qasr Sallum Little Ariba Htan Deryan Kafr Oweijel Alsafira Western Maksour Khalil Abzemo Khan Balat Hmeimeh - Abu Sus - Tannuza Habbuba Eskat Kafr Radwa Karmin Tal Tal Ein Kweires Akula Tal Jakara Halazon Big Orm Al-Asal Halabiyeh Mabuja Um Adase Abaja Salqin Kila Batbu Atareb Hreibel Shgheib Big Eastern Babiri - Delbiya Kafr Little Khantuman Hasel Sabel Totun Koknaya Kelly Jeineh Hazaza Khalilieh Lower Babiri Hamziyeh Takharim Orm Qarras Haddadin Terkan Zubayda Rasm Elkhamis Kaftin Abin Esan Tal Naam Kisumeh Big Qawas Hamra Armanaz Arada Hmeira As-Safira Jbul Hamra Kafr Kafr - Samaan Kafr Azzan Ein Abu Jrin Tal Jarrah Tellemar Shekh Zeitan a Ar-Raqqa Kafrehmul Ketyan Aleppo Bashkwi Hassan Bahr Nabi Qamari Abtin Assan Al-Safira Berna q Kassibeh Sfira Safira Upper Ras El Ein Zanbaqi Kharab Al-Swagheih Bawabiyeh Ziraa Qabtin Murin Mamimeh Nasriyeh q Mediterranean Dorriyeh Zahraa - Habat Iss Kafr Habshiyeh Hekleh Bumane Sultan Foah Teftnaz Rasim Hadher Wadi Kafr Kar Jaara Sheikh Mahsana a Kherbet Amud Toum Sheikh Obeid Banan Tata Um Amud Mujamaa Nasra Zarzur Yousef Bennsh Sahrij Maryuda Elsonue Bluzeh Smad Khefseh Kherbet

Jablah Muhradah

Hama As-Salamiyeh Banyas Tadmor Tartous Masyaf Homs Sheikh Homs Al Makhrim Tartous Badr Dreikish Homs Homs Ar-Rastan Al Makhrim Tadmor